Assessment of the Zulfiqar Frailty Scale (ZFS) in Primary Healthcare.

INTRODUCTION: The primary aim of the study was to validate the Zulfiqar Frailty Scale (ZFS) and examine its concordance with the modified Short Emergency Geriatric Assessment (mSEGA) scale, Part A. METHODS: A prospective observational study was conducted in Guadeloupe (France) over a two-month duration (from 20 February to 20 April 2024), involving elderly individuals aged 65 and older, deemed self-sufficient with an ADL (Activities of Daily Living) score exceeding four out of six. RESULTS: Within this community cohort of 98 individuals, averaging 75 years in age, frailty according to the modified SEGA criteria was prevalent in 29%. Frailty according to the "ZFS" score was prevalent in 40%. Key predictors of frailty identified in our study included age, comorbidity (Charlson score), polypharmacy (total number of medications and therapeutic classes), and functional ability (ADL scores). Notably, experiences of falls and hospitalizations within the past six months significantly influenced the classification of frailty according to both ZFS and SEGA scales. Significant associations with the presence of home care aides (p < 0.0001), monopodal support test results (p < 0.0001), memory impairments (p < 0.0001), and recent hospitalizations (p = 0.0054) underscored the multidimensional impact of frailty. The Pearson correlation coefficient and its 95% confidence interval between the SEGA and Zulfiqar Frailty Scales stood at 0.73 [0.61: 0.81]. The discernment threshold for frailty was set at three out of six criteria, showcasing a sensitivity of 64% and a negative predictive value of 80%. The area under the curve (AUC) for the Zulfiqar Frailty Scale was reported as 0.8. CONCLUSION: The "ZFS" tool allows for the detection of frailty with a highly satisfactory sensitivity and negative predictive value.

[SEGA frailty scale in emergency: back to basics]. / Échelle de fragilité SEGA aux urgences : retour aux sources.

Can the SEGA scale, implemented in the emergency department, effectively predict morbidity and mortality? A prospective study was conducted from January 30, 2018, to July 16, 2018, at the Emergency Department of Chaumont Hospital. Patients aged over 65 were included, while those under 65, in palliative care, or in a life-threatening emergency were excluded. The SEGAm score was calculated for each included patient, and their outcomes were assessed at the end of the emergency department visit and one year later. A total of 278 subjects were included. Vital status at one year was known for all subjects, with no loss to follow-up or censoring. At one year, 56 patients out of 278 (20.1%, 95% CI 15.6% to 25.3%) had died, with less than half of these deaths (n = 25) occurring after readmission to the emergency department or during the emergency visit. The average age was 82 ± 8.2 years, with 158 women and 120 men. Regarding living arrangements, 130 (46.8%) lived at home without caregivers, 100 (36%) lived at home with caregivers, and 48 (17.3%) lived in nursing homes. The average Charlson Comorbidity Index was 5.49 ± 1.99, with an average number of medications of 7.52. The primary methods of referral were as follows: C15 for 144 patients (51.8%), general practitioner for 59 patients (21.2%), spontaneous consultation for 58 patients (20.9%), and family referral for 8 patients (2.9%). The main reasons for admission were falls for 55 patients (19.8%), dyspnea for 33 patients (11.9%), and other reasons for 60 patients (21.6%). Post-emergency department disposition included hospitalization for 167 patients (60.1%) and discharge for 111 patients (39.9%), with no deaths occurring during this period. The SEGAm frailty score (grid A) had an average completion time of 8.18 min ± 3.64. A score of ≤ 8 was found for 85 patients (30.6%), a score between 9 and 11 for 51 patients (18.3%), and a score ≥ 12 for 142 patients (51.1%). In this geriatric population, the risk of death at 12 months was estimated at 31% (95% CI 23.5% to 39.3%) for subjects with a SEGA score exceeding 12, compared to approximately 10% for those with lower SEGA scores. The risk of death or readmission was 52.8% (95% CI 44.3% to 61.2%) for subjects with a SEGA score exceeding 12, compared to 20% to 30% for those with lower SEGA scores. The SEGA score provides valuable prognostic information that is not fully captured by the Charlson score or reason for hospitalization.

Assessing the Efficacy of the Modified SEGA Frailty (mSEGA) Screening Tool in Predicting 12-Month Morbidity and Mortality among Elderly Emergency Department Visitors.

INTRODUCTION: Rapid identification of frail elderly individuals upon admission to the emergency department is pivotal for enhancing their care and alleviating emergency room congestion. OBJECTIVE: This pilot study aims to explore the relationship between morbidity, mortality, and frailty, as assessed by the mSEGA scale, among individuals aged 65 years or older in the emergency department. METHODS: A retrospective cohort study was conducted at a single center. The pilot study included patients aged 65 and above who were admitted to Chaumont Hospital's emergency unit (Haute-Marne department) for medical and/or surgical reasons between 1 July 2017 and 31 January 2018. Data encompassed socio-demographic characteristics, medical profiles, and emergency department visit details. Outcomes for patients one year post-admission were obtained through consultation with their respective general practitioners. RESULTS: A total of 255 subjects participated, with a mean age of 82.1 ± 8.2 years. Primary admission reasons were falls (n = 51, 20.0%), digestive issues (excluding hemorrhage) (n = 30, 11.8%), and "other" causes (n = 61, 23.9%). Among participants, 78 (30.6%) scored ≤8 on the mSEGA frailty scale, 49 (19.2%) scored 9 to 11, and 125 (50.2%) scored ≥12. Concerning post-emergency department outcomes, 152 patients (59.6%) were hospitalized, while 103 (40.4%) were discharged. No deaths were reported during the study period, and vital status was known for all subjects at the one-year mark. At that point, 63 out of 255 patients had passed away, with 30 of them being readmitted to the emergency department either before or at the time of their one-year death. The 12-month survival rate analysis based on frailty status revealed a significant difference. Low-frailty patients exhibited a survival rate of 87.2% (95% CI; [77.5-92.9]), whereas frail/very frail patients had a survival rate of 70.0% (95% CI; [62.7-76.2]). Similarly, the 12-month readmission-free survival rate demonstrated statistically significant disparities. Low-frailty patients had a rate of 76.9% (95% CI; [65.9-84.8]), compared to 51.4% (95% CI; [43.8-58.5]) for very frail patients. CONCLUSION: Utilizing the mSEGA frailty scale in the Emergency Department could provide crucial prognostic insights, highlighting significant differences in 12-month survival and readmission-free survival rates based on frailty status.

[Study of the links between type 2 diabetes and geriatric criteria]. / Étude des liens entre diabète de type 2 et critères gériatriques.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals and is itself considered a "global pandemic". Its prevalence is high and will continue to increase in years to come, becoming more and more prevalent in the elderly and very elderly. We offer a general summary of the work focusing on the links between type 2 diabetes and geriatric criteria.

Early Hospital Discharge Using Remote Monitoring for Patients Hospitalized for COVID-19, Regardless of Need for Home Oxygen Therapy: A Descriptive Study.

AIM: Since beds are unavailable, we prospectively investigated whether early hospital discharge will be safe and useful in patients hospitalized for COVID-19, regardless of their need for home oxygen therapy. POPULATION AND METHODS: Extending the initial inclusion criteria, 62 patients were included and 51 benefited from home telemonitoring, mainly assessing clinical parameters (blood pressure, heart rate, respiratory rate, dyspnea, temperature) and peripheral saturation (SpO2) at follow-up. RESULTS: 47% of the patients were older than 65 years; 63% needed home oxygen therapy and/or presented with more than one comorbidity. At home, the mean time to dyspnea and tachypnea resolutions ranged from 21 to 24 days. The mean oxygen-weaning duration was 13.3 ± 10.4 days, and the mean SpO2 was 95.7 ± 1.6%. The nurses and/or doctors managed 1238 alerts. Two re-hospitalizations were required, related to transient chest pain or pulmonary embolism, but no death occurred. Patient satisfaction was good, and 743 potential days of hospitalization were saved for other patients. CONCLUSION: The remote monitoring of vital parameters and symptoms is safe, allowing for early hospital discharge in patients hospitalized for COVID-19, whether or not home oxygen therapy was required. Oxygen tapering outside the hospital allowed for a greater reduction in hospital stay. Randomized controlled trials are necessary to confirm this beneficial effect.

[Use of the Stopp/Start version 2 tool in an acute geriatric unit]. / Usage de l'outil Stopp/Start version 2 en unité gériatrique aiguë.

INTRODUCTION: Inappropriate drug prescriptions (IP) lead to a high risk of adverse effects, especially for the elderly. Their detection is essential - which can be done using therapeutic lists, including the Stopp/Start scale version 2. METHODS: Observational study - from August 1, 2016, to November 30, 2016, in an advanced geriatric unit at Rouen University Hospital - using the Stopp/Start version 2 list. RESULTS: Eighty-five patients were included, with a ratio of 1.36 women per every man. Sixty-one patients (71.8%) had prescriptions for more than five drugs. The average Charlson comorbidity score was 6.05. One hundred ninety-one IPs were found. Classes E and G (kidney function and respiratory system prescriptions, respectively) were not uncovered. Fifty-four Stopp criteria - 66% of Stopp criteria - never emerged during our study. Using the 34 Start criteria, 187 omissions of prescriptions were found. Classes F and G (endocrine system and urogenital system drugs, respectively) were not observed at any time. Ten criteria were never seen (B3/C1/C4/C5/E6/E7/F1/G1/G2/G3). Nineteen criteria were mentioned less than three times - i.e., in approximately 10% of omissions. CONCLUSION: Our study is part of an approach to protecting the elderly. A significant number of IP and prescription drug omissions were uncovered using this Stopp/Start version 2 tool.

Evaluation of Nutritional Status in an Acute Geriatric Unit: Retrospective Study and Analysis of Frailty Syndrome.

INTRODUCTION: The aim of our study is to evaluate the nutritional status of patients in an acute geriatric unit. METHODS: Patients included in the study were hospitalized in an acute geriatric unit over a period of 6 months. The nutritional status of each patient was evaluated with anthropometric measurements (the BMI and MNA scales), and biological measurements (albumin). Frailty was evaluated using three scales: the Fried scale, the CFS and the modified SEGA scale. RESULTS: A total of 359 patients were included, comprising 251 women (70%) with an average age of 85.28 years. The study showed that 102 elderly subjects were considered undernourished according to the BMI scale, 52 subjects were undernourished according to the MNA scale, and 50 subjects were undernourished according to their albumin levels. The relationships between undernutrition and frailty syndrome studied in our work show that elderly subjects who are undernourished according to the BMI and MNA scales are significantly frail according to Fried and Rockwood, whereas those who are undernourished according to their albumin levels are significantly frail according to Fried and the modified SEGA scale. CONCLUSION: The relationship between undernutrition and the frailty syndrome is close, and their joint screening is necessary, whether on an outpatient or in-hospital basis, in order to prevent negative events related to comorbidities and geriatric syndromes.

Giant cell arteritis in the elderly / Maladie de Horton du sujet âgé

Introduction: Giant cell arteritis (GCA) or Horton's disease is a segmental and focal inflammation of large and medium-sized arteries mostly seen in patients of 50 years and older. There is also a peak frequency in individuals between the ages of 70 and 80. However, clinical data is scarce in this age group and especially in patients over 80. Methods: A retrospective study comprised of patients diagnosed with Horton's arteritis between 2012 and 2017, according to the American Society of Rheumatology, was conducted at Reims University Hospital. Patients were assigned to two groups according to age (≤ 75 and < 75) in order to evaluate and compare the impact of age on diagnosis, treatment and prognosis. Results: A total of 67 patients were studied. The mean age upon diagnosis was 75,85 ±8.5 years; 36 patients (53.7%) 75 years or younger and 31 patients older than 75. There was a female predominance (43 patients), 22 patients aged 75 years or younger and 21 older than 75. The mean follow up duration was 43.02 months in patients aged 75 years or younger and 30.99 in patients older than 75. This represents a difference of more than one year in terms of follow up, but is not statistically significant (p = 0.620). Eleven patients (16.4%) died during follow up: 5 patients (13.9%) aged 75 years or younger and 6 patients (19.4%) older than 75 (p = 0.547). Aortitis was significantly less seen in patients older than 75 (p = 0.0410). Conclusion: Our study showed no significant difference in either age group. However, aortitis was less seen in patients older than 75 years. Patients aged 75 or younger seemed more prone to relapses, but their follow up periods were shorter.

Introduction: L'artérite à cellules géantes (ACG) ou maladie de Horton est une artérite inflammatoire segmentaire et focale des artères de gros et moyen calibre du sujet de plus de 50 ans, avec un pic de fréquence chez le sujet très âgé entre 70 et 80 ans. Dans cette classe d'âge et au-delà de 80 ans, les données cliniques concernant l'AGC sont peu nombreuses. Notre objectif est de documenter ces dernières à travers une étude monocentrique menée sur une population avec une AGC avérée. Patients et méthode: Nous avons mené une étude rétrospective, monocentrique sur les dossiers médicaux de patients diagnostiqués artérite de Horton selon les critères de l'ASR entre 2012 et 2017 au CHU de Reims. Pour évaluer l'influence de l'âge sur le plan diagnostic, thérapeutique, du suivi et du pronostic, nous avons comparé des patients de 75 ans et moins (≤ 75 ans) à ceux de plus de 75 ans (> 75 ans) sur ces différents points. Résultats: Soixante-sept patients ont été inclus. L'âge moyen au diagnostic de ces patients était de 75,85 ± 8,5 ans ; 36 patients (53,7 %) étaient âgés de 75 ans ou moins (dont 22 femmes) et 31 patients (46,3 %) étaient âgés de plus de 75 ans (dont 21 femmes). La médiane de suivi était de 43,02 mois chez les patients ≤ 75 ans et de 30,99 mois chez les > 75 ans, soit près d'un an de différence, mais non significative (p = 0,620). Onze patients (16,4 %) étaient décédés au cours du suivi, 5 (13,9 %) chez les patients ≤ 75 ans et 6 (19,4 %) chez les patients de > 75 ans (p = 0,547). Les patients > 75 ans avaient significativement moins d'aortite (p = 0,0410). Il y avait une tendance à moins de rechute chez les patients de > 75 ans (p = 0,067). Pour les autres symptômes ou anomalies biologiques, les résultats de la biopsie d'artère temporale, la prise en charge thérapeutique, les complications iatrogènes et les décès, aucune différence significative n'était mise en évidence entre les deux groupes (p = ns). Conclusion: Notre étude montre peu de différence en ce qui concerne l'AGC entre les patients > 75 ans et ceux ≤ 75 ans. Toutefois, les patients > 75 ans ont moins d'aortite que les sujets plus jeunes. Il semble également y avoir une tendance à davantage de rechute chez les sujets les plus jeunes, sous réserve d'une durée de suivi plus courte d'un an, cliniquement pertinente, chez les sujets les plus âgés.

Zulfiqar Frailty Scale (ZFS): Concordance Study with the Clinical Frailty Scale (CFS).

Introduction: We designed a new scale for the rapid detection of frailty for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). Objective: To evaluate the performance of the "ZFS" tool to screen for frailty as defined in the Clinical Frailty Scale (CFS) criteria in an ambulatory population of patients at least 75 years old. Method: A prospective study conducted in Alsace, France, for a duration of 6 months that included patients aged 75 and over was judged to be autonomous with an ADL (Activity of Daily Living) > 4/6. Results: In this ambulatory population of 124 patients with an average age of 79 years, the completion time for our scale was less than two minutes, and the staff required no training beforehand. Sensibility was 67%, while specificity was 87%. The positive predictive value was 80%, and the negative predictive value was 77%. The Youden index was 59.8%. In our study, we have a moderate correlation between CFS and ZFS (r = 0.674 with 95%CI = [0.565; 0.760]; p-value < 2.2 × 10−16 < 0.05). The Pearson correlations between these two geriatric scores were all strong and roughly equivalent to each other. The kappa of Cohen (k) = 0.46 (Unweighted), moderate concordance between the ZFS and CFS scales according to Fleiss classification. Conclusion: The "ZFS" tool makes it possible to screen for frailty with a high level of specificity and positive/negative predictive value.

Association of Frailty Status with Risk of Fall among Hospitalized Elderly Patients: A Cross-Sectional Study in an Acute Geriatric Unit.

Introduction: The objective was to study the association of frailty status in hospitalized elderly patients with risk of fall in an acute geriatric unit and to characterize elderly "fallers" using a comprehensive gerontological assessment. Patients and Methods: A cross-sectional study was conducted in patients over 65 years of age and hospitalized in an acute geriatric unit. This work was carried out in the Acute Geriatric Medicine Unit, Saint-Julien Hospital, Center Hospitalier Universitaire de Rouen from 1 June 2016 to 15 August 2016. Results: 172 patients were included during the collection period, with a female predominance of 115 patients (66.9%). The average age of the sample was 79.37 years old (65−85). The average CHARLSON score was 6.93 (3−16). Patients came from home in 81.4% of cases (i.e., 140 patients), and from a nursing home in 18.6% of cases (i.e., 32 patients). The risk of falling, as assessed by the Monopodal Support Test, returned as abnormal for 127 patients. In our series, there was a statistically strong link between the risk of falling and the presence of a dementia pathology (p = 0.009), the presence of a vitamin D deficiency (p = 0.03), the presence of frailty, as assessed by the three scales (modified SEGA scale, Fried scale and CFS/7 (<0.001), a high comorbidity score (p = 0.04), and a disturbed autonomy assessment according to IADL (p = 1.02 × 10−5) and according to ADL (p = 6.4 × 10−8). There was a statistically strong link between the risk of falling and the occurrence of death (p = 0.01). Conclusion: The consequences of the fall in terms of morbidity and mortality and the frequency of this event with advancing age and its impact on the quality of life as well as on health expenditure justify a systematic identification of the risk of falling in the elderly population. It is therefore important to have sensitive, specific, and reproducible tools available for identifying elderly people at high risk of falling.

Physical Activity in the Elderly and Frailty Syndrome: A Retrospective Study in Primary Care.

OBJECTIVES: Physical activity carries numerous therapeutic benefits, and it is more effective when applied before the onset of symptoms. The objective of this study is to compare the correlation of the evaluation of physical activity carried out using the Ricci and Gagnon test and the frailty profile measured by the mSEGA scale in a population of patients consulting in general medicine. METHODS: We conducted a retrospective study within a general practitioner clinic in Chaumont and Bologne (Haute-Marne department) during a 3-month period. Patients aged 65 years and up were screened for frailty using the modified SEGA (mSEGA) assessment, and physical activity was measured using the Ricci-Gagnon questionnaire. RESULTS: A total of 44 patients were selected, with a slightly female predominance (59.1%). Of these, 21 patients reported having worked in manual labor. Seven patients were found to be frail using the SEGAm assessment, while 10 (22.73%) patients had an inactive profile according the Ricci-Gagnon score. Malnutrition was detected in six patients (13.64%) using the MNA survey. Frailty as defined by the mSEGA scale had no statistical correlation (p = 0.68) with the Ricci-Gagnon score. A Ricci-Gagnon inactive profile showed statistical correlations with fall indicators (unipedal balance test, p = 0.014) and malnutrition scores using the MNA (p = 0.0057) as well as with the Charlson Comorbidity Index (p = 0.027). CONCLUSION: A systematic survey of the elderly by a general practitioner implementing a regular and suitable physical activity regimen would allow a better screening of frailty, minimizing its complications.

Giant cell arteritis and scleritis: A rare association.

Background: Giant cell arteritis (GCA) is a vasculitis of the large and medium-sized arteries in the elderly whose ischemic complications adversely affect the eye. The irreversible loss of visual acuity is most often related to acute anterior ischemic optic neuropathy. Very few cases of scleritis have been described in the literature. Case Presentation: The patient presented an obvious case of giant cell arteritis, initially revealed by an ophthalmologic involvement in the form of posterior scleritis, an ear, nose, and throat (ENT) involvement with vestibular and neurological involvement with a type of peripheral neuropathy, all evolving in the context of a weight loss of 8 kg and a marked biological inflammatory syndrome. The patient presented several relapses of giant cell arteritis in the form of several episodes of anterior and posterior, right and left, and even bilateral, isolated scleritis without any other clinical or biological abnormalities, always in conjunction with a decrease in corticosteroid therapy. In the presence of corticosteroid dependence and resistance to methotrexate, tocilizumab was initiated. Conclusion: The therapeutic management of scleritis associated with giant cell arteritis is difficult. In the absence of a codified scheme, the treatment remains empirical, based on the experience of the various teams. In this context, biotherapies (anti-IL6 type, such as tocilizumab) are increasingly used.

Creation of a new frailty scale in primary care: the Zulfiqar Frailty Scale.

Background: Preventing dependency is a public health objective. We want to evaluate the ability of the "Zulfiqar Frailty Scale" (ZFS) tool to detect frailty as defined by Fried's criteria among a group of patients aged 75 and older. Methods: Prospective study conducted in Poitou-Charentes (France) for 12 months on patients aged 75 and over and considered autonomous in terms of the ADL scale. To be eligible, the patients could not reside in a nursing home and needed an ADL score of 4 or higher. Results: Among the group of 200 patients (with a mean age of 81.4 years, +/- 4.82), the prevalence of frailty according to Fried's criteria was 32.5%. The prevalence of frailty according to the "Zulfiqar Frailty Scale" tool was 35.0% and all items except home confinement were significantly associated with frailty. With this tool, the threshold for identifying frailty was 3 out of 6 criteria. It was quick (average completion time of 2 minutes and 2 seconds) with a sensitivity score of 88.0% and a negative predictive value of 91.0%. Conclusion: The "Zulfiqar Frailty Scale" tool measures frailty just as effectively as Fried's criteria, with sensitivity and negative predictive values no lower than the latter.

Obesity and Frailty Syndrome in the Elderly: Prospective Study in Primary Care.

Background: Obesity is a chronic pathology that affects people of all ages, from infants to the elderly, residing in both developed and developing countries. Objective: Our aim is to study the link between obesity and frailty in the elderly. Method: A prospective study was carried out in 12 General Medicine practices in Champagne-Ardenne, in the Departments of Marne and the Ardennes, France, for a period of 12 months (from 2 May 2019 through 30 April 2020). All patients included were aged 65 or older, in consultation with a general practitioner, and had an ADL (Activity of Daily Living) greater than or equal to 4. Frailty was measured using the Fried scale and the simplified ZULFIQAR frailty scale. Results: 268 patients aged 65 and over were included, with an average age of 77.5 years. A total of 100 were obese according to BMI. The mean Fried (/5) in the series was 1.57, and the mean sZFS (/5) was 0.91. Our study shows that obesity is not significantly correlated with frailty according to the FRIED sarcopenic scale, but is significantly correlated with frailty according to the sZFS scale. Conclusions: The link between obesity and frailty remains much debated, with the underlying emergence of sarcopenic obesity equally prevalent among the elderly. This is a preliminary study that should be followed by large-scale outpatient studies to better clarify the links between sarcopenia and obesity.

Activité physique et gériatrie : revue de littérature.

Résumé L'activité physique et sa réalisation chez le sujet âgé demeurent une problématique importante. De nombreuses études ont permis de montrer des bénéfices physiques et psychiques sur la qualité de vie et sur la mortalité. Le maintien d'une activité physique régulière est déterminant pour conserver les capacités fonctionnelles nécessaires aux activités de la vie quotidienne et préserver la qualité de vie des sujets âgés. Abstract Physical activity and its performance in the elderly remain a major problem. Numerous studies have shown physical and psychological benefits on quality of life and mortality. Maintaining regular physical activity is a key to maintain the functional abilities necessary for activities of daily living and preserve the quality of life of the elderly.

Deployment of a remote monitoring solution for the elderly: experiment with an elderly patient / Déploiement d'une solution de télésurveillance du sujet âgé : expérimentation auprès d'un patient âgé

Introduction: Telemedicine can help manage patients suffering from chronic pathologies, particularly elderly patients with numerous comorbidities. We experimented with the e-platform, MyPredi, dedicated to the automated, intelligent detection of situations where patients are at risk of decompensation from geriatric syndromes. We focused our experiment on one particular patient included in the GER-e-TEC study. Methods: The MyPredi platform uses on medical sensors that communicate and relay real-time feedback to an intelligent system of physiological information that analyzes medical ontology, ultimately leading to the generation of alerts. These alerts are linked to a deterioration in the patient's state of health due to a decompensation of chronic pathologies. We reported the results of this experiment for the patient who was participating. Results: The telemedicine solution made 6,073 measurements for the patient throughout his hospitalization, averaging 253 measurements per day. The telemedicine solution issued 110 alerts for the patient during his stay, with an average of 5 alerts per day. The patient had 15 mild alerts, 31 moderate alerts, and 64 severe alerts. In terms of sensitivity, the results are 100% for all geriatric risks and very satisfactory in terms of positive and negative predictive value. Conclusion: MyPredi telemedicine platform enables the generation of alerts in an automatic and non-intrusive way relating to the deterioration of a patient's state of health with regard to geriatric risks.

Introduction: La télémédecine est susceptible d'apporter une aide à la prise en charge des patients souffrant de pathologies chroniques, en particulier les sujets âgés porteurs de nombreuses comorbidités. Dans ce cadre, nous avons expérimenté la e-plateforme MyPredi dédiée à la détection automatisée et intelligente des situations à risque de décompensation des syndromes gériatriques, auprès d'un patient inclus pour l'étude GER-e-TEC (pour geriatrics and e-technology). Méthodes: La plateforme MyPredi repose sur des capteurs médicaux communicants permettant de remonter, en temps réel, à un système intelligent des informations physiologiques, et sur une analyse de l'ontologie médicale, ce qui aboutit in fine à la génération d'alertes. Ces dernières sont liées à une dégradation de l'état de santé des patients en rapport avec une décompensation des pathologies chroniques. Nous indiquons les résultats de cette expérimentation pour le patient inclus. Résultats: La solution de télémédecine a réalisé 6 073 mesures pour le patient durant tout le long de son hospitalisation, avec en moyenne 253 mesures par jour. La solution de télémédecine a émis 110 alertes pour le patient durant son séjour, avec en moyenne cinq alertes par jour. Le patient a eu 15 alertes légères, 31 modérées et 64 sévères. On note une sensibilité de 100 % pour l'ensemble des risques gériatriques, avec des résultats très satisfaisants en termes de valeurs prédictives positives et négatives. Conclusion: En pratique, le système de télémédecine MyPredi permet, de façon automatique et non intrusive, de générer des alertes en rapport avec la dégradation de l'état de santé du patient en ce qui concerne les risques gériatriques.

Zulfiqar Frailty Scale: Overview, Stakes, and Possibilities.

Very few frailty scales are used by general practitioners, as they are time consuming and cumbersome. We developed a frailty screening tool for use in primary care, referred to as the Zulfiqar Frailty Scale (ZFS). This scale was tested in multiple general practitioners' offices in France, and these studies were published. In this paper, we offer a summary of these results.

Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. This was the basis for the "GER-e-TEC COVID study," an experiment involving the use of the smart MyPredi TM e-platform to automatically detect the exacerbation of glycemic disorder risk in COVID-19 older diabetic patients. Methods: The MyPredi TM platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. An experiment was conducted between December 14th, 2020 and February 25th, 2021 to test this alert system. During this time, the platform was used on COVID-19 patients being monitored in an internal medicine COVID-19 unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, positive and negative predictive values with respect to clinical data. Results: 10 older diabetic COVID-19 patients in total were monitored remotely, six of whom were male. The mean age of the patients was 84.1 years. The patients used the telemedicine solution for an average of 14.5 days. 142 alerts were emitted for the glycemic disorder risk indicating hyperglycemia, with an average of 20.3 alerts per patient and a standard deviation of 26.6. In our study, we did not note any hypoglycemia, so the system emitted any alerts. For the sensitivity of alerts emitted, the results were extremely satisfactory, and also in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts and gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (COVID-19 management). Conclusion: This work is a pilot study with preliminary results. To date, relatively few projects and trials in diabetic patients have been run within the "telemedicine 2.0" setting, particularly using AI, ICT and the Web 2.0 in the era of COVID-19 disease.

Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the "GER-e-TEC COVID study". METHODS: This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. RESULTS: 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1.11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. CONCLUSIONS: The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes.